CINCINNATI - In an unpublished opinion, a panel of the Sixth Circuit U.S. Court of Appeals on Sept. 6 affirmed the imposition of a civil monetary penalty (CMP) against a skilled nursing facility for failing to comply with participation requirements set by the Centers for Medicare and Medicaid Services (CMS) (Life Care Center of Bardstown v. Secretary of United States Department of Health and Human Services, No. 12-4420, 6th Cir.; U.S. App. LEXIS 18657).
NEWARK, N.J. - In an unpublished, consolidated opinion, a New Jersey appeals court on Sept. 9 affirmed four financial agency decisions of the New Jersey Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS) terminating appellants from the New Jersey Family Care Medicaid Program (NJFC) (B.D. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-2456-11T3; M.M., et al. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-4744-11T2; T.J. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services; No. A-5761-11T1, G.G. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-0109-12T1, N.J. Sup. Ct., App. Div.).
DENVER - A Colorado federal judge on Sept. 6 granted a motion for a preliminary injunction to stop the implementation of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an owner of for-profit senior care assisted living centers and skilled nursing centers (Stephen W. Briscoe, et al. v. Kathleen Sebelius, et al., No. 13-285, D. Colo.; 2013 U.S. Dist. LEXIS 127510).
SAN JUAN, Puerto Rico - A Puerto Rico federal judge on Sept. 6 held that federal jurisdiction remains in a reimbursement suit brought by dentists and their employers against multiple health insurers following the denial of class certification under the Class Action Fairness Act (CAFA) (College of Dental Surgeons of Puerto Rico v. Triple S Management Inc., No. 09-1209, D. Puerto Rico; 2013 U.S. Dist. LEXIS 127747).
SAN FRANCISCO - A panel of the Ninth Circuit U.S. Court of Appeals on Sept. 4 vacated an injunction prohibiting the secretary of the U.S. Department of Health and Human Services (DHHS) from demanding "up front" reimbursement for secondary payments from beneficiaries who have appealed a Medicare reimbursement determination and remanded the class action case with instructions for the lower court to consider the merits of the plaintiffs' due process claim (Patricia Haro, et al. v. Kathleen Sebelius, No. 11-16606, 9th Cir.; 2013 U.S. App. LEXIS 18353).
WASHINGTON, D.C. - A District of Columbia federal judge on Sept. 5 granted summary judgment in favor of the government in a Medicare dispute, saying that the secretary of the U.S. Department of Health and Human Service (DHHS) did not act arbitrarily or capriciously in denying reimbursements for costs associated with off-site resident training (Borgess Medical Center, et al. v. Kathleen Sebelius, No. 12-144, D. D.C.; 2013 U.S. Dist. LEXIS 126442).
PHOENIX - In a matter of first impression, an Arizona appeals court on Sept. 5 held that the Federal Employee Health Benefits Act (FEHBA) does not preempt Arizona state law forbidding subrogation in personal injury cases (Matthew Kobold v. The Aetna Life Insurance Co., No. 12-0315, Ariz. App., Div. 1; 2013 Ariz. App. LEXIS 187).
MINNEAPOLIS - The Eighth Circuit U.S. Court of Appeals on Sept. 4 affirmed the dismissal of a qui tam lawsuit filed against the Mayo Foundation under the federal False Claims Act (FCA), saying the Mayo Foundation and its related entities filed false and fraudulent claims for reimbursement to the Centers for Medicare and Medicaid Services when the Mayo Foundation and its related entities failed to submit written reports for each permanent surgical pathology slide it created for each patient treated (United States of America, ex rel. David Ketroser, et al., v. Mayo Foundation, et al., No. 12-3206, 8th Cir.; 2013 LEXIS 18330).
ST. LOUIS - A Missouri federal on Aug. 30 denied summary judgment motions made by the parties in a Medicare false claims billing case, finding that a jury could reach a decision in favor of either party (United States of America ex rel. Health Dimensions Rehabilitation Inc. v. RehabCare Group Inc., et al., No. 12-848, E.D. Mo.; 2013 U.S. Dist. LEXIS 123204).
HOUSTON - A Texas federal judge on Aug. 30 granted a motion to intervene in a case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) made by a graduate theological seminary (East Texas Baptist University, et al. v. Kathleen Sebelius, et al., No. 12-3009, S.D. Texas; 2013 U.S. Dist. LEXIS 124347).
KALAMAZOO, Mich. - A Michigan federal judge on Aug. 28 denied a motion to remand a wrongful denial of health care benefits suit to state court and granted the defendant's motion to dismiss, while allowing the plaintiff to amend the complaint (Anne Florence Andrea-Pearson v. Grand Valley Health Plan Inc., No. 12-1223, W.D. Mich.; 2013 U.S. Dist. LEXIS 122331).
NEW ORLEANS - A Louisiana federal judge on Aug. 26 remanded a breach of health care contract suit to state court, finding that the defendant did not show that the amount in controversy for removal to federal court had been met (Omega Hospital LLC v. Blue Cross Blue Shield of Illinois, No. 13-4891, E.D. La.; 2013 U.S. Dist. LEXIS 12195).
EAST ST. LOUIS, Ill. - An Illinois federal judge on Aug. 26 dismissed antitrust claims brought by an outpatient surgery center against a health insurance company and a corporation owning multiple hospitals in Illinois, holding that the plaintiff failed to properly show a relevant market (Marion Healthcare v. Southern Illinois Healthcare, et al., No. 12-871, S.D. Ill.; 2013 U.S. Dist. LEXIS 120722).
JACKSON, Miss. - A Mississippi federal judge on Aug. 26 denied a motion to remand a wrongful denial of health care benefits suit, saying a later-added defendant timely and properly removed the case to federal court (Silas Anderson v. Blue Cross and Blue Shield, et al., No. 13-402, S.D. Miss.; 2013 U.S. Dist. LEXIS 121014).
ATLANTA - In an unpublished, per curiam opinion, a panel of the 11th Circuit U.S. Court of Appeals on Aug. 22 affirmed judgment in favor of a plaintiff in a wrongful denial of benefits suit, agreeing that the plan excluded coverage for injuries received committing felonies and not misdemeanors (Cornelius B. Faison v. Donalsonville Hospital Inc., No. 12-15400, 11th Cir.; 2013 U.S. App. LEXIS 17578).
NEW YORK - A New York justice on Aug. 21 consolidated two disputes related to balance billing and health care reimbursements into one action, moved the location of the consolidated suit and dismissed one of the defendants (Aetna Health Inc., et al. v. Shuriz Hishmeh, M.D., et al., No. 653477/12, N.Y. Sup.; New York Co.; 2013 N.Y. Misc. LEXIS 3702).
PHOENIX - An Arizona federal judge on Aug. 22 denied a health insurance company's motion to dismiss a wrongful denial of benefits suit, saying the court had personal jurisdiction over the case (Jason Brown v. Anthem Blue Cross and Blue Shield, et al., No. 13-990, D. Ariz.; 2013 U.S. Dist. LEXIS 119457).
NEWARK, N.J. - A federal judge in New Jersey on Aug. 22 dismissed claims by a multiemployer health fund seeking to recover from insurers amounts the fund allegedly overpaid to its beneficiaries under the fund's coordination of benefits (COB) provision, finding that the claims did not seek equitable relief under Employee Retirement Income Security Act Section 502(a)(3) (Central States, Southeast and Southwest Areas Health and Welfare Fund, et al. v. Bollinger, Inc., et al., No. 13-2760, D. N.J.; 2013 U.S. Dist. LEXIS 119295).
NEWARK, N.J. - In an unpublished decision, a New Jersey federal judge on Aug. 21 granted summary judgment in favor of a health plan administrator in a reimbursement suit, saying the claims at issue were properly processed (Montvale Surgical Center v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 12-2378, D. N.J.; 2013 U.S. Dist. LEXIS 119630).
WASHINGTON, D.C. - The Federal Trade Commission and the Hospital Authority of Albany-Dougherty County and Phoebe Putney Health System Inc. on Aug. 22 settled FTC charges that the acquisition of Palmyra Park Hospital harmed competition in six Georgia counties (In the Matter of Phoebe Putney Health System, Inc., et al., No. 9348, FTC).
KANSAS CITY, Mo. - A Kansas federal judge on Aug. 14 dismissed a subrogation case brought by a plan beneficiary against a health insurer, saying that the plaintiff failed to exhaust administrative remedies (Richard Barnes v. Humana Inc., No. 13-68, W.D. Mo.; 2013 U.S. Dist. LEXIS 114483).
CHICAGO - In a Medicare reimbursement dispute, an Illinois federal judge on Aug. 15 held that the secretary of the U.S. Department of Health and Human Services (HHS) properly included beds as available and for observational purposes in calculating reimbursement rates but improperly excluded research time from the hospital's resident count (Rush University Medical Center v. Kathleen Sebelius, secretary of Health and Human Services, Nos. 12-4672, 12-4673, N.D. Ill.; 2013 U.S. Dist. LEXIS 115282).
PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on Aug. 16 reversed a putative class action reimbursement dispute against a health insurer, saying the lower court improperly relied on the defendant's competing account of events when dismissing the claim (TRi3 Enterprises v. Aetna Inc., et al., No. 12-2308, 3rd Cir.; 2013 U.S. App. LEXIS 17071).
TRENTON, N.J. - A majority of the New Jersey Superior Court Appellate Division on Aug. 13 held that the state may deny Medicaid benefits to a certain class of legal aliens saying the U.S. Congress has provided leeway to states in funding its Medicaid programs by the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) (Manuel Guaman, et al. v. Jennifer Velez, Commissioner of New Jersey Department of Human Services, et al., No. A-1870-10T2, N.J. Super., App. Div.; 2013 N.J. Super. LEXIS 120).
GREENVILLE, S.C. - A federal judge in South Carolina on Aug. 12 granted summary judgment to two legislative defendants in a lawsuit seeking injunctive and protective relief for violations of the Americans with Disabilities Act (ADA) and Medicaid statutes (Kobe and Mark v. Nikki Haley, in her capacity as Governor and Chairman of the South Carolina Budget and Control Board, et al., No. 3:11cv1146, D. S.C., Greenville Div.; 2013 U.S. Dist. LEXIS 113193).